Gastroenteritis In Primary School Children (A Case Study Of Akoli-Imenyi Central School, Abia State)

Project and Seminar Material for Microbiology

Gastroenteritis In Primary School Children (A Case Study Of Akoli-Imenyi Central School, Abia State)


Abstract


This study was carried out on gastroenteritis in primary school children. The study was limited to Akoli-imenyi central school, Abia state. Gastroenteritis, also known as infectious diarrhea is a common cause of morbidity in young children. Gastroenteritis. In order to accomplish the purpose of the present study, the survey research design was used. The data for this study were generated from two main sources; Primary sources and secondary sources. The population for the study comprised of mothers whose children Akoli-imenyi primary school. A sample of 300 mothers was utilized for the study. Out of the 300 copies of the questionnaire distributed, 284 copies were used for data analysis. The instrument for data collection was the researcher – designed questionnaire.

The responses were coded on computer coding sheets, thereafter the Statistical Package for the Social Sciences (SPSS) the result showed that Mothers of the various age groups possessed high (ranging from 61.33% – 85.59level knowledge in the various dimensions of gastroenteritis except those of age group 20-29 years who had average (57.67) knowledge of the preventive measures of gastroenteritis. Mothers had very high knowledge (84.95%) of the signs and symptoms of gastroenteritis.

Mothers adopted various gastroenteritis management practices such as promptly cleaning a baby who defecated (90.5%), continue breast feeding baby especially during diarrhoea (88.7%), boiled water used in making drinks for the children (85.6%), prepared food hygienically during diarrhoea episode (83.1%), washed hands with soap and water in preparing ORS (75.75), mixed ORS in the right proportion (73.65) and gave ORS as soon as diarrhoea starts (72.2%). The study recommended that more scientific research should be conducted in Akoli-imenyi central school on factors that hinder the management of gastroenteritis by mothers. This is essential for developing rational and effective intervention to the problem.


Table Of Contents


Preliminary Page(s)

  • Title page
  • Certification page
  • Dedication
  • Acknowledgement
  • Abstract
  • Table of content

Chapter One

Introduction

  • 1.1 Background to the Study
  • 1.2 Statement of the Problem
  • 1.3 Purpose of the Study
  • 1.4 Research Questions
  • 1.5 Hypothesis of the study
  • 1.6 Justification / Significance of the Study
  • 1.7 Scope of the Study
  • 1.8 Operational definition of terms

Chapter Two

Review of Related Literature

  • 2.1 Conceptual Framework
  • 2.2 Theoretical Framework
  • 2.3 Empirical Studies on Knowledge and Management Practices of Mothers
  • 2.4 Summary of Literature Review

Chapter Three

Research Methodology

  • 3.1 Introduction
  • 3.2 Area of study
  • 3.3 Research Design
  • 3.4 Sources of Data
  • 3.5 Population for the Study
  • 3.6 Sample and Sampling Techniques
  • 3.7 Instrument for Data Collection
  • 3.8 Validity of the instrument
  • 3.9 Reliability of the instrument
  • 3.10 Method of Data Collection
  • 3.11 Method of Data Analysis

Chapter Four

Results And Discussions

  • 4.1 Introduction
  • 4.2 Results
  • 4.3 Summary of Findings
  • 4.4 Discussion

Chapter Five

Summary, Conclusions And Recommendations

  • 5.1 Summary
  • 5.2 Conclusions
  • 5.3 Implications for Health Promotion
  • 5.4 Recommendations
  • 5.5 Suggestions for further studies
  • References
  • Appendix

Chapter One


Introduction

1.1 Background to the Study

Gastroenteritis is a common cause of morbidity in young children. Gastroenteritis, also known as infectious diarrhea, is inflammation of the gastrointestinal tract—the stomach and small intestine. Symptoms may include diarrhea, vomiting and abdominal pain. Fever, lack of energy and dehydration may also occur. This typically lasts less than two weeks. It is not related to influenza, though it has erroneously been called the “stomach flu”.
Diarrhoea accounts for high levels of mortality in young children in developing countries like Nigeria, despite worldwide efforts to improve overall child health levels. Each year, in the developing countries of Asia, Africa and Latin America, approximately five million children under five years of age die from acute diarrhoea.

About 80 per cent of these deaths are in the first two years of life (Lucas & Gilles, 2009) In the developing world as a whole, about one-third of infant and child deaths are due to diarrhoea and approximately 70 per cent of diarrhoeal deaths are caused by dehydration – the loss of large quantity of water and salts from the body, which needs water to maintain blood volume and other fluids to function properly (Gupta & Mahajan, 2005). UNICEF (2002) submitted that in Nigeria, infant mortality rates are twice as high in rural settings as they are in urban ones due to poor hygiene and poor sanitation. Of the annual 3 million infant births in Nigeria, approximately 170,000 result in deaths that are mainly due to poor knowledge and management practices of gastroenteritis. Several factors are likely to contribute to the very high gastroenteritis morbidity and mortality rates, in children under-five years including poverty, female illiteracy, poor water supply and sanitation, poor hygiene practices and inadequate health services (Park, 2009). Malnutrition is another established risk factor for mortality among children with gastroenteritis disease. This may be due to inadequate case management. The first line of management of gastroenteritis, is therefore, the prevention of dehydration. This can be achieved at home using Oral Rehydration Therapy (ORT).

Diarrhoea is the disturbance of the gastrointestinal tract comprising of changes in intestinal motility and absorption, leading to increase in the volume of stools and in their consistency (Ballabriga, Hilpert & Isliker, 2000). In gastroenteritis, stool contains more water than normal stool and is often called loose or watery stool. In certain cases, they may contain blood in which case the gastroenteritis is called dysentery (Obionu, 2001). Any passage of three or more watery stools within a day (24 hours) is referred to as gastroenteritis (Tauxe, 1997). The consistency and the volume of stool constitute how to classify gastroenteritis.

World Health Organization – WHO (1993) classified gastroenteritis as acute or persistent based on its duration. An episode of gastroenteritis that lasts less than two weeks is acute diarrhoea, while diarrhoea that lasts more than two weeks is persistent. Morley (2000) further classified diarrhoea according to its typology: Secretary diarrhoea, osmotic diarrhoea and exudative diarrhoea. Secretary diarrhoea results from active process in the intestinal epithelium stimulated by the presence of toxin, chemical or nutritional product in the intestinal linning. Osmotic diarrhoea is caused by the presence of the intestinal linning of osmotically active solutes that are poorly absorbed by the injection of laxatives such as magnesium sulphate or magnesium hydroxide. Exudative diarrhoea is associated with damage to the mucosa lining leading to outpouring of mucus, blood and plasma protein among other substances. However, it is important to note that the classification of diarrhoea does not influence the cause.
Gastroenteritis is a symptom of infection caused by a host of bacterial, viral and parasitic organisms most of which can be spread by contaminated water. Gastroenteritis in most cases is caused by three major groups of micro-organisms namely; Viruses, bacteria and protozoa or parasites (Lucas & Gilles, 2009).

The main agents of gastroenteritis according to them are enteroviruses (e.g. rotavirus, escherichia coli, campylobacter spp, shigella, vibrio cholera, salmonella (non typhoid), entamoeba histolytica, giardia lamblia, cryptosporidium). These are further grouped in the following ways: Viruses (e.g. Rota virus); Bacteria (e.g. shigella, escherichia coli, vibrio cholerae, salmonella non typhoid, campylobacter spp). Parasites (e.g. entamoeba histolytica, crytosporidium and giardia lamblia). All over the world, viruses especially rotavirus has been identified as the major cause of acute diarrhoea in children. Studies in Nigeria also found viruses as the major causes of diarrhoea in 60 per cent of cases with bacteria responsible for about only 3-20 per cent. Most of these pathogens are transmitted by faeco-oral route. Gastroenteritis within the context of this study refers to any type of loose, watery stool that occurs more frequently than usual in a child. The various causative agents vary according to the signs and symptoms manifesting from the disease.

The main consequence of gastroenteritis are frequent loose or watery stools, the risk of dehydration, damage to intestine (especially when there is bloody diarrhoea) and loss of appetite with or without vomiting. However, Victoria, Bryce, Fountaine and Monasch (2000) asserted that signs of dehydration are not evident until there is acute fluid loss of approximately 4-5 per cent of body weight. The signs and symptoms of dehydration include sunken fontanelle, dry mouth and throat, fast and weak pulse, loss of skin elasticity and reduced amount of urine. This loss leads to shock and untimely death of under-five. Werner (2001) noted that dehydration takes its heaviest toll on infants and children under-five. The signs and symptoms according to Longmach, Wilkinson and Rajagopalan (2004) are passage of frequent loose watery stools, abdominal cramps or pain, fever particularly if there is an infectious cause and bleeding. Bacteria and parasites often can produce bloody diarrhoea (dysentary). In addition, inflammatory bowel disease, polyps and colorectal cancer can cause blood and mucus in the stools, nausea and vomiting may also be present in the case of infection.

The main dangers of gastroenteritis are dehydration and malnutrition (WHO, 1993). Dehydration according to WHO is most often caused by loss of a large amount of water and salt from the body, while malnutrition can be caused by an inadequate diet due to poverty, a lack of appropriate foods or incorrect beliefs about feeding, frequent infections of which diarrhoea is one of them.

Spradley and Allender (1996) stated that the most common modes of transmission of diarrhoea are contaminated food and water, dirty feeding utensils (especially feeding bottles and teats) and the faecally contaminated fingers of the infants or the mother. Infection occurs through ingesting food contaminated with adequate doses of Salmonella, and Shigella or E. Coli. The cycle begins when the infectious agent multiplies and grows in the food medium. The agent subsequently invades the host upon ingestion of the food.

There are other physical modes of transmission of gastroenteritis as identified by the United Nations Children’s Fund – UNICEF (1998). These include: poor source of water supply, especially in rural areas; poor environmental sanitation leading to attitudinal problems of defecating in open spaces, pit latrine, bushes and in the streams (used for drinking and bathing). Feeding bottle is also a feature of infection (Federal Rebublic of Nigeria – FRN 2002). Lucas and Gilles (2009) also maintained that transmission of gastroenteritis occurs by the faecal-oral route due to poor standards of personal and environmental hygiene. These conditions will determine the seriousness of infection of gastroenteritis. The most important aspect of managing a child with diarrhoea are preventing or treating dehydration and maintaining good nutrition.

These preventive practices according to WHO (1993) include breast feeding, improved weaning, use of plenty of water for hygiene and clean water for drinking, hand washing, use of latrines, proper disposal of the stools of young children, use of Oral Rehydration Therapy (ORT) and Oral Rehydration Solution (ORS) and immunization against measles. Cutting (1994) stressed that drinking extra fluid in the early stages of gastroenteritis is crucial in preventing dehydration and subsequent death. He also noted that the combination of giving more fluid than usual as soon as gastroenteritis starts and continuing feeding is an effective home therapy for gastroenteritis. The knowledge and practice of these becomes necessary for the mothers in the issues of gastroenteritis.

Traditionally, mothers are expected to spend most of their time in the house, looking after their children and carrying out other domestic functions. It may be right and natural, therefore, that the first person to manage a gastroenteritis episode at home is possibly the mother. Mothers on this basis have been identified as the most important people involved in the management of gastroenteritis, hence mothers are used for this study. Landy (1992) referred to them as the key persons and managers of the home. She asserted that people, especially mothers possess adequate knowledge about their baby’s health and disease prevention. Thus, they are recognized as very important persons for the smooth running of the family, including supervision of health of their children. Macleans (1998), on his own part, accorded mothers the traditional responsibility of looking after their children with regard to weaning and nursing care. This, according to him, is because of their being close to their children. This situation is similar to the relationship between mothers and their children in Akoli-imenyi central school. As asserted by Davely and Wilson (1981) and Bethann, Gopel, Douglas and Lynn (1992), literate mothers are better able to look after their children than non-literate ones. Thus, those who possess the appropriate knowledge are more likely to be able to take the appropriate action to protect their children especially the under five (childhood).

According to Hodges (2001) childhood is a period of rapid physical growth, including the development of the brain almost to its full adult size, and is also a critical period for the development of the cognitive functions. He further added that the key factors for child growth and development are adequate care, good health, nutrition and stimulation. Inadequate nutrition and care in the first few years of life can seriously interfere with brain development and lead to such neurological and behavioural disorders as learning disabilities (Bargley, 1996). Childhood in the context of this study means the condition or period of being a child or a young human being below the age of five. The knowledge of adequate and quality childhood care could lead to healthiness of the child in terms of prevention of early childhood diseases like gastroenteritis.

Knowledge according to Winifred (1989) is accumulated facts, truth, principles and information to which human mind has access. Knowledge can be defined as the sum of conceptions, views and propositions which has been established and tested (Conforth, 1996). The Nigerian Education Research Council – NERC (1982) asserted that an educated and knowledgeable person is one who understands, among other things the basic facts concerning health and disease and protects his or her own health and that of the community. WHO (1995) also maintained that if a person is well informed in the area of health, he or she would be able to reject practices that imperil his or her health. The individual will also be well equipped to make the right decision concerning the children and family, and will play active role in improving the society in which the person lives. In the context of this study, knowledge refers to the act of having adequate information and understanding of the concept, signs and symptoms, modes of transmission and management practices of gastroenteritis by the child bearing mothers. Adequate or high level knowledge of the concepts, signs and symptoms, mode of transmission of gastroenteritis is capable of guaranteeing proper management practices of gastroenteritis among children.

Management according to Osinem (2008) is the co-ordination of all the resources of an organization through the process of planning, organizing, directing and controlling in order to attain organizational objectives. Koontz and Weighrich (2005) described management as the process of designing and maintaining an environment in which individuals working together in groups efficiently accomplish selected aims. Management as defined by wikipedia, the free Encyclopaedia (2007) is the art and science of getting things done through others. It can also refer to the person who performs the act of management. Management in this context involves childbearing mothers doing or producing something like proper breastfeeding, washing feeding bottles, washing plates and hands, keeping the environment clean and producing oral rehydration solution to cope with gastroenteritis. Ekenedo (1994) noted that there was a relationship between knowledge and management practice adopted by mothers. She concluded that better life will not come from mere acquisition of knowledge but from its practice.

Practice, according to Hornby (2001) is a way of doing something that is common or habitual; it is a way of doing something or expected way in a particular situation. Funks and Wagnalls (2003) defined practice as any customary action or proceeding regarded as individuals habit. Sally (2004) further defined practice as an established way of doing things especially one that developed through experience and knowledge. When management relates to practice, it becomes management practice.

Bucher (1994) perceived management practice as the application of good health actions to ones daily living such as proper personal hygiene and nutrition. In this study, management practices refer to all the actions that are undertaken by mothers to avert gastroenteritis. There are many such management practices.

WHO (1993) identified a number of management practices and these are: breast feeding, Oral Rehydration Therapy(ORT), weaning practices, use of plenty of water for hygiene and use of clean water for drinking, hand washing, use of latrines, safe disposal of stools of young children and measles immunization. Early knowledge and practice of these in the home may increase the chances of its efficacy and likely reduce complications following gastroenteritis. It is most likely that mothers who are the home-makers will make use of them in order to save their children when they are informed. Okafor (1993) opined that women are better able to understand information and follow instructions if their level of education and information should be raised. The way of determining if women possess adequate knowledge regarding gastroenteritis is to assess the level of knowledge they possess about the aspects of the disease.

Level of knowledge and practice can be ascertained in numerous ways. Ashur (1977) opined that a proportion of less than 40 per cent correct response should be taken as indicator of low level of knowledge, 40 – 59 per cent is considered average and 60 – 80 per cent is considered high, while over 80 per cent is regarded as very high level of knowledge. Okafor (1997) modified Ashur’s four scales of measurement into five scales by carving two levels that is, 10-20 per cent as “very low” and 21-39 per cent as “low” out of Ashur’s proportion of less than 40 per cent described as “low” level of knowledge. The Ashur’s (1977) principle was adopted in the present study to determine the knowledge and management practices of childhood diarrhea by mothers in Akoli-imenyi L.G.A.

This study was carried out in Akoli-imenyi L.G.A of Abia State, with its headquarter at Aguobu Owa. The inhabitants of the area are mainly farmers, civil servants and traders. The possible sources of water supply range from the use of stream, tanker water to the occasional use of tap water. They also use rain water during rainy seasons. General environmental sanitation is poor as there are no facilities for refuse disposal. They make use of open refuse dumps to dispose of refuse – dumping them into nearby bushes, burn them or dumped by the roadside.

They use pit latrines and nearby bushes for sewage disposal. However, some wellto-do families make use of water closet system. Some are literate while others are not. The sociodemographic factors that may influence this study include; education, age and parity of the women. This is because an educated mother might use health information more than the uneducated counterparts (Okafor, 1993). Their age and parity also differed and might have conferred different levels of experience which may also affect the management of gastroenteritis. Studies such as those of Rao, Vinod, Mishra and Rutherford (1998), which revealed that more educated women were more likely than less educated women to manage gastroenteritis in children. Ekenedo (1994) found that age and parity level might affect the rate at which gastroenteritis is managed. This revelation which was made by Ekenedo (1994) Sixteen years ago and confirmed by Rao et al (1998) – might have influence on mothers in Akoli-imenyi central school where the present study will be carried out.

desire to effect change in behaviour for reducing the risk of future illness according to Philips (1991) should be based upon theoretical models that identify predictors of behavioural change. Several models or theories concentrate on the significance of sociocognitive variables in preventive health. Theoretical models relevant to gastroenteritis knowledge and management practices among mothers in the context of the present study will include the following: health action process approach, systems management theory and self efficacy theory.

The extents to which mothers in Abia state portray their knowledge and management practice of gastroenteritis do not appear to have received adequate research attention. This cannot be less true about mothers in Akoli-imenyi central school. Finding out these, certainly, will represent a positive step forward in the effort to promote the gastroenteritis knowledge and management practices. Following from these therefore, one is then inclined to ask, what is the level of knowledge possessed by mothers in Akoli-imenyi central school of Abia state towards the gastroenteritis and what management practices do they adopt?
The above in essence, represent the reason of this study.


1.2 Statement of the Problem

Adequate and accurate knowledge has been admitted as a prerequisite for the adoption of desirable health behaviour. WHO (1995) asserted that when a person is well-informed, the individual will be equipped to make the right decision concerning the health of the children and family and will take an active role in improving the society in which the person lives. Mothers should have adequate knowledge of the childhood diseases, among which diarrhea is one. This knowledge which they gained from the different MCH clinics should help the mothers to take adequate and accurate care of their children.

Regrettably, in spite of the knowledge gained by these mothers, childhood diarrhea is found to be the second main cause of under-five mortality the world over, in the developing countries and in Nigeria in particular. It is not unlikely that low level of knowledge of mothers in Akoli-imenyi central school may militate against the effective performance of diarrhea prevention practices.

It is against this background of the cases and magnitude of diarrhoeal diseases, its associated implications and complications and the need for child safety and health promotion that the researcher was motivated to ascertaining the knowledge and management practices of childhood diarrhea by mothers in Akoli-imenyi central school of Abia State.


1.3 Purpose of the Study

The purpose of the study is to find out the knowledge and management practices of gastroenteritis in primary school children (A case study of Akoli-imenyi central school, Abia state).

Specifically, the study intends to find out:

  1. Level of knowledge of the concept of diarrhoea possessed by mothers in Akoli-imenyi central school;
  2. Level of knowledge of the signs and symptoms of gastroenteritis possessed by mothers.
  3. Level of knowledge of modes of spread or transmission of diarrhoea possessed by mothers.
  4. Level of knowledge of the dangers of gastroenteritis possessed by mothers in Akoli-imenyi central school.
  5. Level of knowledge of preventive measures against gastroenteritis possessed by mothers.
  6. The management practices of gastroenteritis by mothers in Akoli-imenyi central school;
  7. The difference in the knowledge of mothers about gastroenteritis according to level of education;
  8. The difference in the management practices of mothers about gastroenteritis based on level of education;
  9. The difference in the knowledge of mothers about gastroenteritis based on age;
  10. The difference in management practices of mothers about gastroenteritis based on age;
  11. 1The difference in the knowledge of mothers about gastroenteritis based on parity;
  12. The difference in the management practices of mothers about gastroenteritis based on parity.

1.4 Research Questions

The following research questions were formulated to guide the study;

  1. What is the level of knowledge possessed by mothers regarding concept of gastroenteritis ?
  2. What is the level of knowledge possessed by mothers regarding signs and symptoms of diarrhoea?
  3. What is the level of knowledge possessed by mothers regarding modes of transmission of gastroenteritis ?
  4. What is the mother’s level of knowledge of the dangers of gastroenteritis ?
  5. What is the level of knowledge possessed by mothers regarding the preventive measures of gastroenteritis ?
  6. What are the management practices of mothers regarding gastroenteritis in Akoli-imenyi L.G.A?
  7. What is the difference in the level of knowledge of mothers regarding gastroenteritis according to level of education?
  8. What are the differences in the diarrhoea management practices of mothers regarding diarrhoea according to level of education?
  9. What is the difference in the level of knowledge of mothers regarding gastroenteritis according to age?
  10. What are the differences in the management practices of mothers regarding gastroenteritis according to age?
  11. What is the difference in the level of knowledge of mothers regarding gastroenteritis according to parity? and
  12. What are the differences in the management practices of mothers regarding gastroenteritis according to parity?

1.5 Hypothesis of the study

HO: Gastroenteritis does not exist among primary school children in Akoli-Imenyi Central School.

H1: Gastroenteritis exists among primary school children in Akoli-Imenyi Central School.


1.6 Justification / Significance of the Study

Information, of both local and foreign origin abounds regarding gastroenteritis in Nigeria. The study will ginger interest in the area of childhood health and disease in Nigeria. Mothers especially childbearing women will benefit from the result of the study as it will provide them with appropriate information on the concept, signs and symptoms, modes of transmission and the preventive measures of gastroenteritis. This will enable the women to make informed choices on the adoption of the management practices. Appropriate knowledge will influence them and enhance their practice. It will also help them in educating the public on the preventive measures of gastroenteritis. Low level of knowledge on the other hand will equally compel health policy makers to step up efforts in the area of education, seminars, workshops especially in rural areas with a view to raising the level of knowledge of the people regarding gastroenteritis and its management practices.

The result on the management of gastroenteritis by mothers will be useful to mothers and caregivers. Appropriate practice will be encouraged and allow these mothers and caregivers to carry out these practices in the already established direction. On the other hand, inappropriate practice will call for adjustment and improvement and provide enlightenment efforts to achieve better results. Specifically, the data to be generated on the management practices of mothers may likely sensitize the mothers on the gastroenteritis in Akoli-imenyi central school to encourage identified sound practices while engineering changes in the unwholesome practices of mothers towards gastroenteritis.

The findings of differences in the level of knowledge and management practice according to level of education will be useful to mothers, caregivers and institutions of learning. These mothers and caregivers by level of knowledge, who had adequate knowledge and appropriate practice may be encouraged. Those with low level of knowledge and inappropriate practice may be exposed to education and enlightenment interventions by health workers that will enhance their knowledge and management practice of gastroenteritis.

The findings will be useful to the general public who may need appropriate information on gastroenteritis. Researchers will benefit from the study. They can build on the findings for further research is this area of knowledge. The data concerning this study may help to enrich the pool of data on the subject matter. Such data may also be beneficial to both Health and Education ministries in Abia state, and may form the basis for future policy formulation and modification.

The study has identified some of the demographic factors associated with the knowledge and management practices of gastroenteritis. This will help health workers to know the group of mothers that needs more education on gastroenteritis. These adjustments will facilitate understanding and corresponding behaviour among mothers concerning gastroenteritis. When this happens mothers will be convinced to adopt appropriate practices in managing diarrhoea cases. The end product of this will be a morbidity and mortality decline.

Finally, scholars and reading public will benefit from the theoretical significance of the study. It will contribute to the synthesis of the relevant theories in the field of study. It seeks to explain why people think, feel, and act the way they do. The study will add to the existing literature in the field of health education and child health in particular.


1.7 Scope of the Study

The study was delimited to mothers whose children are in primary school in Akoli-imenyi central school of Abia state. The study was concerned with finding out the gastroenteritis level of knowledge and management practices of mothers in Akoli-imenyi.


1.8 Operational definition of terms

Diarrhoea:

Diarrhoea is when your bowel movements become loose or watery. The definition of diarrhoea is passing loose or watery bowel movements 3 or more times in a day (or more frequently than usual). Diarrhoea occurs when the lining of the intestine is unable to absorb fluid, or it actively secretes fluid.

Gastroenteritis:

Gastroenteritis, also known as infectious diarrhea and gastro, is inflammation of the gastrointestinal tract—the stomach and small intestine. Symptoms may include diarrhea, vomiting and abdominal pain. Fever, lack of energy and dehydration may also occur. This typically lasts less than two weeks.

Children:

Biologically, a child (plural children) is a human being between the stages of birth and puberty, or between the developmental period of infancy and puberty.


Chapter Five


Summary, Conclusions And Recommendations

5.1 Summary

The purpose of the study was to investigate the knowledge and management practices of gastroenteritis in primary school children in Akoli-imenyi central school. In order to accomplish this purpose, twelve specific objectives and corresponding research questions were formulated. Six null hypotheses were postulated for verification. Three socio-demographic variables, namely: age, level of education and parity were investigated. Literature pertinent to the study was reviewed under the following headings: conceptual framework, factors associated with knowledge and management practices of childbearing mothers regarding gastroenteritis , theoretical framework and emperical studies on knowledge and management practices of mothers.

The survey research design was adopted for the study. The study population comprised of 3000 registered mothers attending MCH clinics in Akoli-imenyi central school at the time of the study. The multi-stage sampling procedure was utilized to draw the sample. At each of the three stages employed, an appropriate sampling technique was adopted. This process produced a sample of 300 respondents which constituted ten per cent of the total number of registered mothers attending MCH clinics in Akoli-imenyi central school at the time of study.

The researcher designed questionnaire known as Diarrhoea Knowledge And Management Practices Questionnaire – DIKAMPQ that constituted three sections A,B, and C was the instrument utilized for collection of quantitative data. Five experts in the Department of Health and Physical Education and Science Education, University of Nigeria, Nsukka, validated the instruments. Split-half was used to determine the reliability of the instrument (DIKAMPQ) while Spearman-Brown Prophecy (correlation) formula was used to establish reliability co-efficient at the sub-scales. Kuder-Richardson 21 formula was used to determine internal consistency of section C of DIKAMPQ which comprised dichotomously – scored items of “yes” or “no”. Percentages using Ashur’s criteria for describing level of knowledge were utilized for answering the research questions while ANOVA statistic was adopted to verify null hypotheses one, two and four. Chi-square ((χ2) was utilized for verification of postulated null hypotheses three, five and six.

Out of the 300 copies of the questionnaire distributed, 284 copies were used for data analysis. The SPSS batch system was employed for data analysis. The findings of the study indicated that:

  1. Mothers had high (71.21%) level of knowledge of the concept of gastroenteritis (KG). This is contained in Table 1.
  2. Mothers had very high (84.94%) level of knowledge of the signs and symptoms of gastroenteritis. This is contained in Table 2.
  3. Mothers had high (76.58%) level of knowledge of the modes of transmission of gastroenteritis. This is contained in Table 3.
  4. Mothers had high (77.82%) level of knowledge regarding the dangers of gastroenteritis . This is contained in Table
  5. Mothers had high (60.28%) level of knowledge regarding the preventive measures of gastroenteritis. This is contained in Table 5.
  6. Majority of mothers adopted all the management practices of gastroenteritis ranging from 72.2%- 90.5% except “giving their babies only breast milk during diarrhoea (42.3%) and (35.6%) mothers who allowed their children to defecate in bushes or open spaces. This is contained in Table 6.
  7. Mothers of all the levels of education possessed very high level of knowledge of SSG and high level of knowledge of G, MTG, DG and PMG while only those with tertiary education possessed average level of knowledge of PMG.
    This is contained in Table 7.
  8. Higher proportion of mothers with tertiary education adopted all the listed diarrhoea management practices percentage ranging from 15.8% – 38.7% except allowing a child to defecate in the bush more than those with no formal, primary and secondary education. This is contained in Table 8.
  9. Mothers of the various age groups possessed high (ranging from 61.33% – 85.59level knowledge in the various dimensions of gastroenteritis except those of age group 20-29 years who had average (57.67) knowledge of the preventive measures of gastroenteritis. This is contained in Table 9. Lower proportion of (ranging 13.4% – 34.2%) CBMs‟ of age group 20-29 years adopted the listed management practices: continuing breast feeding when baby has diarrhoea, preparing wearing food hygienically during diarrhoea, boiling water used in making drinks, using boiled water in preparing ORS, promptly cleaning a baby who has defecated during diarrhoea, mixing ORS in the right preparation, washing hands with soap and water before preparing ORS and giving baby ORS as soon as diarrhoea starts, except in giving baby only breast milk during diarrhoea and allowing a baby who has diarrhoea to defecate in bushes or open spaces more than those in age group 30-39 years and 40-49 years. This is contained in Table 10.
  10. Mothers of all the parity statuses possessed high level of knowledge ranging from (61.24% – 87.99%) of the various dimensions of gastroenteritis except those of parity status 5 and above who possessed average (57.99%) knowledge in PMG. This is contained in Table 11.
  11. Lower proportion of the mothers (ranging from 35.2% – 45.4%) of parity status 2-4 adopted all the listed diarrhoea management practices except giving baby only breast milk when he/she has diarrhoea and allowing a child who has diarrhoea to defecate in bushes or open spaces more than mothers‟ of parity status 1 and 5 and above. This is contained in Table 12.

5.2 Conclusions

Based on the findings and discussions of the study, the following conclusions were attained;

  1. Mothers had high knowledge (71.21%) of the concept of gastroenteritis. This answers research questions 1.
  2. Mothers had very high knowledge (84.95%) of the signs and symptoms of gastroenteritis.. this answers the research question 2.
  3. Mothers had high knowledge (76.58%) of the modes of transmission of gastroenteritis. This answers research question 3.
  4. Mothers had high knowledge (77.82%) of the dangers of gastroenteritis. This answers research question 4.
  5. Mothers had high knowledge (71.21%) of the preventive measures of gastroenteritis. This answers research question 5.
  6. 6. Mothers adopted various gastroenteritis management practices such as promptly cleaning a baby who defecated (90.5%), continue breast feeding baby especially during diarrhoea (88.7%), boiled water used in making drinks for the children (85.6%), prepared food hygienically during diarrhoea episode (83.1%), washed hands with soap and water in preparing ORS (75.75), mixed ORS in the right proportion (73.65) and gave ORS as soon as diarrhoea starts (72.2%). Whereas lower proportion of the mothers gave their babies only breast milk during diarrhoea (42.35) and allowed their children who has diarrhoea to defecate in bushes or open spaces (35.6%). This answers research question 6.
  7. The overall level of knowledge for mothers with tertiary education in the various dimensions of gastroenteritis was very high, while those without formal education, primary and secondary education had high level of knowledge. This answers research question 7.
  8. Level of education had no difference in the management of practices of mothers regarding gastroenteritis. This answers research questions 8.
  9. Mothers of the different age groups possessed high level of knowledge in the various dimensions of gastroenteritis except those of age group 20-29 years who had average (57.67%) of the preventive measures of gastroenteritis. This answers research question 9.
  10. Mothers of age group 20-29 years adopted the various management practices regarding gastroenteritis more than mothers aged 30-39 years and 40-49 years respectively. This answers the research question 10.
  11. Mothers of all the parity statuses possessed high level of knowledge of the various dimensions of gastroenteritis except those of parity status 5 and above who possessed average knowledge in PMG. This answers research question 11.
  12. Lower proportion of mothers of parity status 2-4 adopted the management practices more than those of parity status 1 and 5 and above. This answers research question 12.
  13. There was no significant difference in the level of knowledge of mothers regarding the various dimensions of gastroenteritis according to age. This tests hypothesis one.
  14. There was no significant difference in the level of knowledge of the SSCG and PMG, while there was significant difference in the level of knowledge of G, MTG and DG according to level education of the mothers. This tests hypothesis two.
  15. There was no significant difference in the listed management of practices of mothers: continuing breast feeding during diarrhoea, preparing weaning food hygienically during diarrhoea, boiling water used in making drinks for the children, using boiled wastes in preparing ORS, promptly cleaning a baby after defecation especially during diarrhoea, mixing ORS in the right proportion and giving baby ORS as soon as diarrhoea starts, and there was significant difference in the practices of allowing a child who has diarrhoea to defecate in bushes or open spaces during diarrhoea, washing hands with soap and water before preparing ORS and giving baby only breast milk during diarrhoea episode according to parity status. This tests hypothesis three.
  16. There was no significant difference in the level of knowledge of mothers regarding the various dimensions of gastroenteritis : G, SSG, MTG, DG and PMG according to parity status. This also tests hypothesis four.
  17. There was significant difference management practices of mothers with respect to giving ORS in the right proportion, allowing a child who has diarrhoea to defecate in \bushes or open spaces, boiling water used in preparing ORS and washing hands with soap and water before preparing ORS. There was no significant difference in the management practices of mothers with regards to boiling water used in making drinks for children especially during diarrhoea, continuing breast feeding during diarrhoea, promptly cleaning a baby who has defecated especially during diarrhoea, giving baby only breast milk during diarrhoea, and preparing hygienically weaning food during diarrhoea according to age. This also tests hypothesis five.
  18. There was no significant difference in the management practices of mothers regarding gastroenteritis with respect to promptly cleaning a baby after defecation especially during diarrhoea, giving baby only breast milk during diarrhoea, boiling water used in making drinks for children and preparing weaning food hygienically especially during diarrhoea according to level of education. There was significant difference in the management practices of mothers with respect to continuing breast feeding during diarrhoea episode, boiling water used in making ORS for their children during diarrhoea, allowing a child who has diarrhoea to defecate in bushes or open spaces, mixing ORS in the right proportion, washing hands with soap and water before preparing ORS and giving ORS as soon as diarrhoea starts according to level of education. This tests hypothesis eight.

5.3 Implications for Health Promotion

Increasing occurrence of diarrhoeal diseases among the under-five children call for post-natal child health care education and general education of both nursing and pre-school age caring mothers in order to improve on their children’s national status, improve on hygiene care status and environmental sanitation. Child health care should be taught at various levels of education by health and allied educators. In addition, matrons and nurses in charge of antenatal and post natal clinics should periodically teach mothers, especially the non-literate on healthy feeding habits, hygiene habits and especially the advantages of proper exclusive breast-feeding over bottle feeding, effective family planning, so as to reduce the number of children to a manageable size that parents could properly look after.

Thus, health education of women of childbearing age would result to hygiene and sanitation problems that might predispose the under-five children to diarrhoeal diseases and by implication infant mobility and mortality rate in the communities.


5.4 Recommendations

Based on the finding and conclusion of this study, the following recommendations were drawn:

  1. The health workers at the various MCH in Akoli-imenyi central school should strengthen their teachings on the management practices of mothers regarding gastroenteritis. Since these mothers varied in their responses in all the management practices.
  2. More scientific research should be conducted in Akoli-imenyi central school on factors that hinder the management of gastroenteritis by mothers. This is essential for developing rational and effective intervention to the problem.
  3. All methods of ORT should be uniformly taught to mothers so that they can have a variety of choice based on conveniences to them.
  4. Since there was significant difference in the knowledge and management practiced of mothers regarding gastroenteritis according to level of education. The state government should provide free and compulsory education for both younger and older mothers to enable then acquire education up to tertiary level so as to widen their scope in all spheres of life including health issues such as gastroenteritis.

5.5 Suggestions for further studies

  1. Research work should be concentrated on the demographic factors that facilitate the management practices of mothers regarding gastroenteritis.
  2. Studies should also be conducted to determine cultural factors that predispose mothers to poor management of gastroenteritis.

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